New insights into the psychosocial aspects of irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) is a common condition varying in severity from trivial to incapacitating. The more severe cases are associated with poor quality of life, absenteeism from work, frequent consultation with medical professionals, and psychosocial distress. Historically the disorder was often considered as purely psychosomatic in origin, but we now know that this is a gross oversimplification. Gastrointestinal disorders are better understood using the biopsychosocial model, which emphasizes the importance of biologic and psychosocial factors. This article reviews the epidemiologic association of IBS with psychological and social stresses and explores how such stresses may influence consulting behavior and outcome. This review also describes physiologic mechanisms that may be involved in IBS and discusses the role of psychological therapies and psychotropic medication in the treatment of this condition.

Gastro‐esophageal reflux and antisecretory drugs use among patients with chronic autoimmune atrophic gastritis: a study with pH‐impedance monitoring

“…Functional disorders are a frequent cause of gastrointestinal symptoms also at the level of the esophagus and are associated with psychological comorbidity. Most of the evidence for this association in the literature relates to functional dyspepsia and irritable bowel syndrome . The observation that in patients with altered t ‐score at SCL‐90 the risk of being symptomatic was unrelated to a positive MII‐pH study strongly suggests that a functional component was important with regard to our patients' symptoms.…”

Cognitive-behavioral therapy for the management of irritable bowel syndrome

“…Psychological disturbance, especially in referred patients, includes psychiatric disorders (e.g., panic disorder, generalized anxiety disorder, mood disorder, and post-traumatic stress disorder), sleep disturbance, and dysfunctional coping [27] . A history of childhood abuse is common [19] .…”

“…It has been indicated that up to two-thirds of patients with IBS in tertiary care centers have demonstrable psychiatric illness [28][29][30] , and that these patients have a worse prognosis than those who are psychologically normal [31] . Approximately 50% of patients with a psychiatric disorder develop the condition before the onset of gastrointestinal symptoms, and psychiatric symptoms start at the same time in most of the remaining 50% [27] . Recently, it has been demonstrated that psychosocial factors, as an indication of the process of somatization, are independent risk markers for the development of IBS in a group of subjects previously free of IBS [32] , and that the effect of psychosocial factors is strongest in severely affected IBS patients [33] .…”

Síndrome do ceco móvel e as doenças gastrintestinais funcionais

“…17 Diante de toda complexidade envolvida na caracterização da doença, dos aspectos fisiopatológicos desconcertantes, da ausência de um marcador biológi-co e dos marcantes fatores psicossociais -síndrome do pânico, ansiedade generalizada, distúrbios do estado afetivo, alteração na capacidade de lidar com situações estressantes, distúrbios do sono e não raramente uma história pregressa de abuso físico e sexual [18][19][20] -é lícito supor o marcante caráter psicogênico da doença, mas nada impede o raciocínio em sentido contrário; ou seja, que toda a rica sintomatologia não esclarecida e mal resolvida possa ser, no seu conjunto, os fatores etiológicos das inaptidões psicossociais mencionadas.…”